NURS 231 Module 3 Exam2.

NURS 231 / NURS 231 b b b b




FINAL EXAM (Latest 202 b b b




):
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Multidimensional Care I b b




V / MDC 4 - b b b b




Rasmussen 2021
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A patient is receiving dobutamine [Dobutrex] as a continuous infusion in
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the immediate postoperative period. The patient also is receiving a diur
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etic. What adverse drug reactions are possible in this patient? (select all
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that apply) b




a)Angina b)Hypo b




tension c)Dysrhy b




thmias d)Oliguria b




e)Tachycardia - ANSWER-a)Angina b b

,c)Dysrhythmias e b




)Tachycardia


RATIONALE*Is a beta1 aderenergic agonist; general anesthetics can incre b b b b b b b b



ase the likelihood of dysrhythmias. Dobutamine elevates BP by increasing
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CO. Diuretics complement the beneficial effects of dobutamine on the ki
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dney, so urine output would be increased, not decreased.
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A patient who has severe sepsis is receiving an intravenous normal saline
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infusion. She weighs 78 kgs. Which of the following is an indicator that t
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he therapeutic goal has been met?
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a) 250 mL of urine in the past 6 hours
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b) Arterial blood pressure is 90/42 b b b b




c) Central Venous Pressure is 2 mm Hg b b b b b b




d) Patient's heart rate is 101 - ANSWER- b b b b b b



a) 250 mL of urine in the past 6 hours
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RATIONALE*Fluid resuscitation goals in sepsis are: MAP > 65, UO . 0.5 mL/ b b b b b b b b b b b b



kg/hr, and/or CVP 8-12 mm Hg.
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The nurse is preparing to administer lisinopril (Zestril) to a patient with ac
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ute coronary syndrome. Which of the following findings should
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,prompt the nurse to hold the medication and consult the healthcare provi
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der?
a) Serum sodium level 134 b b b




b) Serum potassium 5.6 b b




c) Heart rate 58 b b




d) Blood pressure 125/78 - ANSWER-b b b b




b) Serum potassium 5.6 RATIONALE*ACE inhibitors can cause/ex
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acerbate hyperkalemia. b




The nurse is caring for a patient who is in hypovolemic shock following an
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extensive burn injury. What is the intravenous fluid of choice for this pati
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ent in the emergent phase of treatment?
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a) Lactated Ringers b




b) 0.45 NS with 20 mEq potassium chloride
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c) Fresh Frozen Plasma b b




d) 5% Dextrose in saline - ANSWER-a) Lactated Ringers
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RATIONALE*Isotonic solutions (crystalloids) are used to restore fluid volu b b b b b b b b



me in patients with shock. Lactated Ringers is isotonic. Normal saline is al
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so isotonic.
b




The client on a ventilator is assessed for untoward responses to the thera
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py. Which of the following would indicate a possible complication of venti
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lator therapy?b




a) Blood pressure has increased 5mmHg in the last 24 hours
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b) Lung sounds absent on one side.
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, c) Forceful cough periodically b b




d) Broncho-vesicular breath sounds throughout peripheral lung fields. - b b b b b b b



ANSWER-b) Lung sounds absent on one side.
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RATIONALE*This may indicate a pneumothorax-- b b b b



a complication caused by barotrauma.
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The nurse is caring for Mrs. B, who has a pulmonary embolus. She is start
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ed on a heparin drip and 4 hours later the aPTT is 70 seconds (lab control o
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r "normal" value is 40 secs). The nurse should:
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a) Notify the provider and request an order for warfarin (Coumadin).
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b) Notify the provider and request a decrease in the heparin dose.
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c) Continue the present order for heparin. b b b b b




d) Hold the heparin and notify the physician. - ANSWER-
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c) Continue the present order for heparin.
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RATIONALE*The aPTT is therapeutic for a heparinized patient with a PE. A b b b b b b b b b b b



therapeutic aPTT for a heparinized patient is 1.5-
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2x the "normal" or "control" value. Review also the heparin protocol calc
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ulations. We did an example on the PE case study.
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A patient with a diagnosis of myocardial infarction is admitted to your un
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it. Which of the patient's statements would alert you to the possibility of
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bacute heart failure? b b




a) "I think my dose of digoxin may need to be increased."
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b) "I have noticed a lack of appetite lately."
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